title: Plan-provider integration, premiums, and quality in the Medicare Advantage market.
abstract: OBJECTIVE
  To investigate how integration between Medicare Advantage plans and health care providers is related to plan premiums and quality ratings.
  
  
  METHODS
  We used public data from the Centers for Medicare and Medicaid Services (CMS) and the Area Resource File and private data from one large insurer. Premiums and quality ratings are from 2009 CMS administrative files and some control variables are historical.
  
  
  METHODS
  We estimated ordinary least-squares models for premiums and plan quality ratings, with state fixed effects and firm random effects. The key independent variable was an indicator of plan-provider integration.
  
  
  METHODS
  With the exception of Medigap premium data, all data were publicly available. We ascertained plan-provider integration through examination of plans' websites and governance documents.
  
  
  RESULTS
  We found that integrated plan-providers charge higher premiums, controlling for quality. Such plans also have higher quality ratings. We found no evidence that integration is associated with more generous benefits.
  
  
  CONCLUSIONS
  Current policy encourages plan-provider integration, although potential effects on health insurance products and markets are uncertain. Policy makers and regulators may want to closely monitor changes in premiums and quality after integration and consider whether quality improvement (if any) justifies premium increases (if they occur).
authors.affiliation: Health Care Financing and Economics, VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Boston University School of Medicine, Boston, MA; Health Policy and Management, Boston University School of Public Health, Boston, MA; Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA.
authors.forename: Austin B
authors.initials: AB
authors.lastname: Frakt
authors.forename: Steven D
authors.initials: SD
authors.lastname: Pizer
authors.forename: Roger
authors.initials: R
authors.lastname: Feldman
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S. / Q000706:statistics & numerical data; D006801:Humans; D007341:Insurance / Q000458:organization & administration; D020398:Medicare Part C / Q000191:economics / Q000458:organization & administration*; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration*; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D018511:Systems Integration; D014481:United States
keywords: Medicare; health care; health economics; industrial organization